Provider Demographics
NPI:1962744748
Name:SPENCER, ANN KIMBALL (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:KIMBALL
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LOS RANCHOS RD NW
Mailing Address - Street 2:#38
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6520
Mailing Address - Country:US
Mailing Address - Phone:505-503-8852
Mailing Address - Fax:
Practice Address - Street 1:520 LOS RANCHOS RD NW
Practice Address - Street 2:#38
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6520
Practice Address - Country:US
Practice Address - Phone:505-503-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-080241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical